Integrative medicine, a new landscape of healthcare innovation - will it work?
Thaomunglung Chukhrungfa
Hospital Manager | Healthcare Business Strategist | Lean Six Sigma Expert | Intrapreneur
Innovation is creating something new; productivity is the measure of input Vs output; Healthcare innovation implies the developments leading to health outcomes and patient experience. Recent Covid19 experience and changing the speed of healthcare innovation and the newer developments in the areas of vaccination, artificial intelligence, machine learning, and biopharma developments are creating a new landscape in the healthcare world. Here, let us have a bird’s eye view of the innovation in the “Delivery System” from the perspective of wellness and integrative medicine getting momentum and changing the other dynamics of healthcare. This change may strongly impact the healthcare industry to shift the current scope and paradigm from disease focus to patient focus. The quest for an answer here is If that happens, will it create a stronger ecosystem to deliver better care and focus on health holistically, and will it succeed in making health possible with accessibility, affordability and quality of care? There might be different hypotheses and scenarios for drawing some inferences from an innovation point of view in the Indian context.
WHY INNOVATION: While the whole world longs for health and wellness the modern health system is struggling to meet the needs of affordability, accessibility and quality of care. This is mainly due to the huge disease burden globally. Other associated reasons are the doctor-to-patient ratio, nurse-to-patient ratios etc. The shortfall in the provider side is becoming a great challenge for any of the government and systems. There have been different initiatives and improvements over the last few years for bridging the gap. The growing shortfall in healthcare demand and supply has been tried to be filled up by the government through social welfare initiatives at the community level along with establishing medical colleges and hospitals to increase the facility and manpower resources. Even today, the maternal mortality rate or the neonatal mortality rates are hovering around the dreading figures of losing 4 mothers’ lives in every 1000 childbirth- can we imagine this? In a general observation around, a typical geriatric patient within a home atmosphere could be under so many medications that it could be equal in numbers of the other nutritional items they take on a daily basis. There are so many instances of old patients under medication of five-six medicines a day on the lower side to maintain their health. Should it be only pill, pill, pill when comes to health? or the other option by patients to take themselves to the operation room or should we focus more on our habits and activities to remain fit and happy?
Consumers' response to the unbridgeable gap of supply and demand is giving creating new consumer options. Day by day increasing peoples’ participation in care delivery, information asymmetry and democratization of medicine are taking place. This is becoming visible in the urban scenario and the customer's voice is growing clearer seeking a solution for meeting the unmet needs to shape up something new in the coming times. This speculation is all about understanding the integrative approach of healthcare delivery that the west today is adopting and India is following suit. Major disease burden of communicable and non-communicable and chronic ailments like cancer, tuberculosis, hypertension, Diabetes, mental health conditions of insomnia etc., are diseases with huge burden globally and needs comprehensive approach for healing. While Health-tech innovations through Metaverse, Artificial Intelligence, and Machine Learning is creating a congenial environment for increasing productivity, quality and better clinical outcome, emergent dynamics of health delivery from the systems perspective will definitely be undeniable.
HEALTHCARE SYSTEMS PERSPECTIVE: Primary, secondary and tertiary care networks in our health system define a general division of care based on severity and emergencies and this hierarchical structure needs more interlinking connections for a successful care process and therefore needs a lot of improvement. While the major surgeries and treatment facilities are centred around high-end technologies, bigger hospitals and metro cities the primary care in the urban areas is catered through the clinics. In rural India, healthcare provision is limited to the Primary Health Centers. Secondary and tertiary care remains a farfetched dream even today for people in villages. Addressing the weaker link of primary care delivery in this area carries a lot of possibilities from the health innovation perspective.
Similarly, curative, preventive and promotive care delivery is also intersecting in many of its aspects when we talk about different streams of care starting from modern medicine, AYUSH and other wellness streams. As such traditional medicine covers the scope of health promotion to a very wide level while the interventional and curative aspect is attributed largely to modern medicine.
INTEGRATIVE MEDICINE: Evolving from other nomenclatures, the American definition of integrative medicine has grown from the allied medical service. To define the health provision, the support systems of other disciplines like physiotherapy, meditation, Yoga etc., are considered within this. Integrated medicine or integrative medicine as it is referred to in the United States is practising medicine in a way that selectively incorporates elements of complementary and alternative medicine into comprehensive treatment plans alongside solid methods of diagnosis and treatment. The concept is better recognized in the US than in the United Kingdom. Integrated medicine is not simply a synonym for complementary medicine. Complementary medicine refers to treatments that may be used as adjuncts to conventional treatment and are not usually taught in medical schools. Integrated medicine has a larger meaning and mission, its focus is on health and healing rather than disease and treatment. It views patients as whole people with minds and spirits as well as bodies and includes these dimensions in diagnosis and treatment. It also involves patients and doctors working to maintain health by paying attention to lifestyle factors such as diet, exercise, quality of rest and sleep, and the nature of relationships. Integrative medicine focuses on the patient as a whole person and not just the illness or disease. While it seeks to understand the underlying cause of the symptoms or condition, it does so by looking at the complete mind, body and spirit. Integrative medicine uses an evidence-based approach to improve health and wellness. Integrative medicine believes that physical, mental, emotional and spiritual needs affect health. It believes those needs rely on each other and affect the entire well-being. There are many different aspects to address, so integrative medicine uses a combination of therapies and lifestyle changes. With integrative medicine, the relationships between patients and healthcare providers are important. Patients are equal partners in their healing process. Integrative medicine aims for well-coordinated care among different providers and specialists. It brings together conventional healthcare approaches like medication and psychotherapy and complementary therapies like acupuncture and yoga. In this way, integrative medicine “integrates” all aspects of patients’ well-being to achieve optimal health and healing.
WHO DOES IT? HOW DOES IT HELP? A variety of healthcare providers deliver care through integrative medicine. These providers may include Physicians, Naturopathy doctors, Holistic mind-body psychotherapists, Acupuncturists, Chinese herbal therapists, Tai chi practitioners, Yoga practitioners, Massage therapists, Nutritionists, Chiropractic doctors, Chefs or culinary medicine specialists etc. in America and Europe. Integrative medicine does not replace the primary care provider or specialist. They work together with all members of the healthcare team to heal patients’ minds, bodies and spirits. Their expertise lies in preventing and managing chronic diseases. They don’t treat acute medical problems. For acute care and medical emergencies, the patient should be referred to emergency medicine or a specialized physician.
WHO IS INTEGRATIVE MEDICINE FOR? Many people can benefit from integrative medicine, including healthy people. People with long-lasting, chronic or complex conditions may especially find the approach helpful. Integrative medicine can help patients in finding relief for many health and medical conditions, including autoimmune diseases, Acute and chronic pain, Breathing disorders, Headaches and migraines, Cancer and cancer-related side effects, Chronic fatigue, Cold/flu symptoms, Digestive disorders, Infertility, Menopausal symptoms, Menstrual issues, Mental and emotional health issues, Obesity, High blood pressure (hypertension), Sleep issues, anxiety etc. Pain management can be effectively handled with complementary healthcare provisions like Ayurveda, Naturopathy, Yoga etc. Insomnia and other mental health conditions which could be threats to a better lifestyle can be well managed by the discipline of Yoga. Along with modern medicine, the implementation of the AYUSH stream can show good results in combating these issues. Examples of common practices include Acupuncture, Animal-assisted therapy, Aromatherapy, Dietary and herbal supplements, Massage therapy, Music therapy, Meditation, Resilience training, Tai chi or Yoga and Naturopathy.
Recommended by LinkedIn
WHAT ARE THE BENEFITS OF INTEGRATIVE MEDICINE? Integrative medicine techniques support the body’s natural ability to heal. It helps people to reduce stress and promotes a state of relaxation that leads to better health. It can help patients achieve optimal health when they engage in one’s own healing and feel empowered to make lifestyle changes. Adding integrative medicine to the healthcare routine can help regain control of an individual’s well-being.
ADOPTION: Wide utilization of integrative medicinal approaches and an increasing trend is seen in the United States, Canada and other American and European countries. Cleveland and Mayo Clinics have already adopted this trailblazing care delivery process. In India, AIIMS opened the Centre for Integrative Medicine and Research in the year 2016. This centre is a pioneering initiative in the quest for the convergence of contemporary medicine with India’s ancient and traditional medical practices. The Centre at the premier institute of the country aims to research, document and delivery of holistic healthcare. It has been envisioned as a “state of the art” research centre where top experts from various disciplines of contemporary medicine will collaborate with Yoga and Ayurveda specialists, both for disease treatment and for preventive healthcare. All national newspapers flashed the news of Apollo hospital acquiring a 60% stake in the AyurVaid on 6th October 2022. This is a clear indication that India’s biggest private healthcare player setting foot in integrative medicine. Treatment stages range from Preventive Care, Acute-on-Chronic Care, Post-Emergency Care, and Promotive Care. AyurVAID pioneered cashless Ayurveda treatments through leading insurance companies and institutional tie-ups. Apollo Hospitals’ acquisition of the stake in AyurVAID is aimed at delivering a unique Co-Managed Care Model, offering appropriate integration between modern medicine and Ayurveda. The Global Ayurvedic Market has been growing at an average annual rate of 16.2 per cent since 2015, reflecting the rising demand for complementary medicine and therapeutic wellness experiences. 18th November 2022 Naturopathy Day is being celebrated with the theme of “Integrative Medicine”.
NEW RHETORIC ON BUSINESS MODEL INNOVATION: This model could generate many hypotheses in the innovators' minds for looking at healthcare delivery as a system and deriving many inferences for prototyping and rolling out as a new solution. The model encompasses all the streams including evidence-based clinical practices and what is perceived as a “good thing for health” and conjoins all of them together to create some solution for health delivery. This model could draw some of the hypotheses for utilization as a referral program for patient interdisciplinary care. Or this could trigger some innovation around creating a hub and spoke system for service distribution of primary care and centralization of tertiary care services. Another possibility could be the utilization of the model mixed with market reach-out programs for a business generation which would create employment and service hand in hand. The incubation of this model from the startup perspective also could be initiated. Institutional adoption in a modern hospital could step up the service provision for the post-operative care delivery process in hospitals, homes and halfway homes like rehab centres. Home care service gaps could also be considered for the purpose.
CHALLENGES: What are the risks of integrative medicine? All recommended therapies and lifestyle changes are very safe with minimal risk. But the treatments are not substitutes for regular medical care from the primary care physician and specialists. The treatments promoted in integrative medicine are not substitutes for conventional medical care. Certain therapies and products are not recommended at all. Or they may not be recommended for certain conditions or people.
PATIENT-PROVIDER PERSPECTIVE: From the Patient Perspective, today in India, awareness about the possible integration of healthcare service is still remaining missing in the masses. Affordability and accessibility are other issues at the current moment. From the Provider's point of view Research in the area of Integrative medicine is very rare. Therefore, with no specific funding for research into integrative medicine, evidence will not be forthcoming. However, even when research funds are available there may be few high-quality applications. There is still a need to foster research excellence in this discipline. In addition, there are no clear guidelines for the regulation of, and training in, integrative medicine for licensed health professionals who want to use this therapy in their practice. Familiarization with complementary therapies needs to start in medical schools and other institutes of higher education. There are also Policy level Challenges for practising Clinicians as the policy changes and guidelines are almost unavailable. Structural Challenges in the form of protocols and institutional service delivery have not been seen in the Indian context so far.
To conclude, it is a very congenial time to stimulate the innovators' DNA to check the different hypotheses and narratives being created in this sphere of the health delivery ecosystem. It is obvious that the world now is heading towards a new phase. Is it integrative medicine which will be able to sort out the issues of accessibility? Will it work to decrease the disease load that today’s world going through? Is it actually going to be another megatrend? Is it a positive change in the healthcare world? Let us deep dive to ignite some more thoughts on this wind of change.
References: